Pharm Exam II Flashcards
Which of the following is a symptom of acute cholinergic toxicity?
Bradycardia
(Muscarinic symptoms)
-SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, GI discomfort, Emesis
-DUMBBLESS: Diarrhea, Urination, Miosis, Bronchorrhea, Bradycarida, Emesis, Lacrimataion, Salivation, Sweating
(Nicotinic symptoms)
-muscle cramps
-tachycardia
-weakness
-twitching
-fascultations
A drug that has an effect of increased gastric emptying:
Increased absorption
GI absorption is ______ by meds that inhibit gastric emptying (example: atropine, anticholinergic, opiates)
slowed
GI absorption is _______ by meds that increase gastric emptying (example: metoclopramide, Reglan)
increased
- Competition for protein binding sites
- Alterations in “free” drug concentrations
- Impact secondarily on elimination
These describe:
Distribution
- Enzyme induction (Phenytoin, Carbamazepine, Rifampin, Theophylline)
- Enzyme inhibition (Allopurinol, Ciprofolxacin, Paroxetine, Fluoxetine, Cimetidine)
These describe:
Metabolism
- Tubular secretion
- Altered urine flow and urine pH
These describe:
Excretion
What ions are associated with phase 0?
Na
What ions are associated with phase 1?
Na
What ions are associated with phase 2?
Ca
What ions are associated with phase 3?
Ca & K+
What ions are associated with phase 4?
Ca
What phase of cardiac action potential is being described?
RAPID DEPOLARIZATION, sodium channels open
Phase 0
What phase of cardiac action potential is being described?
PARTIAL REPOLARIZATION, sodium channels close
Phase 1
What phase of cardiac action potential is being described?
PLATEAU, calcium channels open
Phase 2
What phase of cardiac action potential is being described?
REPOLARIZATION, calcium channels close, potassium channels open
Phase 3
What phase of cardiac action potential is being described?
PACEMAKER/RESTING, degradation of membrane potential, slowly calcium channels
Phase 4
Refractory period in which the heart CANNOT be stimulated:
Absolute
Refractory period in which a greater than normal stimulus may initiate a response:
Relative
Which of the following medications has a high risk of QT prolongation & TDP?
-Amiodarone
-Bretylium
-Dofetillide
-Ilbutilide
-Dronedarone
-Sotalol
A BIG DOG IS DARN SCARY
What is TDP?
Torsades de Pointes- a specific type of ventricular tachycardia that begins in your heart ventricles
Which of the following is an “irreversible” indirect cholinergic agent?
-Novachok agents
(organophosphates which include novachok agents, insecticides, & nerve agents)
Which of the following is an arrhythmia that results in a HR of less than 60 BPM?
Bradycardia
(Tachycardia is greater than 100 BPM)
Vaughn-Williams classifies:
Antiarrhythmic medications
List the following Vaughn-Williams classifications:
Class I:
Class II:
Class III:
Class IV:
Class V:
Class I: Na+ channel blockers
Class II: Beta-adrenoreceptor blockers
Class III: K+ channel blockers
Class IV: Ca++ channel blockers
Class V: Miscellaneous
Which receptor minimizes the potential for dry mouth?
M3- glandular/smooth muscle; gastric acid, salivary secretion, GI contraction, occular accommodation, vasodilation
Which is a neurohormone?
Epinephrine
neurohormone: any hormone produced and released by neuroendocrine cells into the blood
Which of the following drugs causes dry mouth & urinary hesitancy?
Disopyramide (norpace)
(This is Class Ia antiarrhythmic mediation)
-also causes constipation & QT prolongation
Which of the following mediations is likely to result in dry mouth & sedation due to its effects at the histamine receptor?
Diphenhydramine (Benadryl)
Which medication increases cardiac contractility by inhibiting PDE3?
Milrinione- phosphodiesterase inhibitor
Positive inotropic medications contribute to:
the ability of the heart to contract
- Cardiac glycosides (Digoxin)- inhibits Na-K ATPase
- DOBUTamine-B1 adrenoreceptor agonist
- Milrinione- phosphodiesterase inhibitor
- Levosimendan- calcium sensitizer
Which of the following mediations undergoes a pharmodynamic interaction and negates the beneficial effect of albuterol?
Propanolol (Inderal) a beta blocker
Which of the following is beta-1 specific?
Metoprolol
Which one of the following is considered a non-covalent type of interaction?
Formation of hydrogen peroxide
Which of the following medications has a high risk of gingival hyperplasia?
Verapamil
Which of the following is most commonly associated with gingival hyperplasia?
Phenytoin (Dilantin)
POST-ganglionic SYMPATHETIC releases:
Norepinpehrine (NE)
POST-ganglionic PARASYMPATHETIC releases:
Acetylcholine (Ach)
AUTONOMIC PRE-ganglionic releases:
Acetylocholine (Ach)
Regeneration of AchE:
Pralidoxime
First line treatment for patient exposed to nerve gas:
Pralidoxime
What do you give a patient with anaphylaxis?
0.3 mg IM epinephrine
Short-acting beta-2 agonist in asthmatic patients:
Albuterol
Which drug metabolism phase functions impair with age:
Phase 1
Blocks calcium from entering type L channels:
Nifedipine
What contributes to cardiac output?
Stroke volume & heart rate
Which ion is required to bind actin to myosin to produce cardiac contractility?
calcium
Which drug inhibits the Na/K ATPase?
Digoxin
Which commonly occurs during pregnancy?
Increased renal blood flow & GFR
Which increases cardiac contraction by stimulating myocardial B1 receptors?
DOBUTamine
Which is a short-term temporizing agent for hypotension & also serves as a nasal decongestant?
Phenylephrine
What are three endogenous catecolamines?
Dopamine, Norepinephrine, Epinephrine
Myocardial oxygen demand is determined by:
HR & myocardial contractility
Characteristic of alpha-1-adrenergic receptor activation:
increased sympathetic tone
Which of the following results from covalent modification and alteration of DNA?
Mutagenesis
Adverse effect independent of drug main mechanism:
Aspirine & tinnitus
Meds most likely to be associated with development of anaphylactic shock:
Penicillin
Example of pharmacodynamics:
Constipated from Ach block
Which of the following drugs has the greatest risk of causing orthostatic hypotension?
Terazosin
Ethnic variation..that some individuals of chinese…this is because of increased concentrations of:
Acetylaldehyde
Acetylcholine is broken down by which of the following enzymes?
Acetylcholinesterase
Which of the following does beta-1 NOT do?
Bronchodilation
Fluoxetine is and SSRI antidepressant and inhibits cytochrome P45O 2D6. Risperidone is an antipsychotic and is a substrate for P450 2D6. What effect would you expect fluoxetine to have on risperdone in terms of drug concentration?
Risperdone levels increase (he used different drug examples)
Atrial depolarization:
P wave
Which of the following is a depolarizing neuromuscular blocker?
Succinylcholine
What tertiary amine…something something (all but 1 were quarternary):
Atropine
A drug that treated cholinergic toxicity would NOT treat:
paralysis
Prozac inhibits which liver enzyme?
2D6
Which type of blockade causes a patient…if they go from supine immediately standing:
Alpha-1 blockade; orthostatic hypotension
Which drugs are contraindicated in patients with asthma?
All of the above
-opiates
-aspirin
-antihistamine
